Intradiscal electrothermal annuloplasty, known as IDET for obvious
reasons, has been used successfully since 1999 to assist patients
manage pain eminating from the intervertebral disc. IDET is catagorized
as a percutaneous minimally invasive spine surgery. Disc disease may
be due to trauma to the disc or degeneration, but in either case results in
the development of fissures in the disc through which leak potent
enzymes produced inside the disc. These enzymes cause pain by
inflamming the nerves inside the spinal canal. The fissures or tears in
the disc are located by discography. The technique involves placement of
a needle into the disc, then passing a thermal catheter through the needle
and into the disc. The catheter is heated to approximately 196 degrees F
over a 16 minute period, during which time the collagen in the disc
shrinks slightly, causing the disc to slightly decompress. Also, it is
possible the nerves which have abnormally grown into the disc, are
damaged by the heat from the catheter. Nevertheless, by whatever
mechanism, the IDET procedure works in approximately 60-70% of
patients who receive over 50% relief. Typically, patients will begin to
experience relief weeks to months later after the IDET procedure.
Potential complications include needle penetration of the dura with
resultant spinal headache, infection of the disc, bleeding into the
epidural space or muscle, injury to the spinal nerves, and other more
minor complications such as muscle soreness, etc.
Alternatives to IDET include Selective Endoscopic Annuloplasty,
Disctrode, Artificial Disc Replacement, or spine fusion surgery.
Optimal candidates for IDET are those with discography positive
annular tears without disc herniation and less than 50% height loss in the
disc with predominate back and or leg pain. Patients who do poorly with
IDET are the morbidly obese. Medicare and Medicaid will not pay for the
procedure and therefore it is not performed in patients with these types
of social healthcare coverage.
After IDET, patients must be careful to not bend too far foward,
engage in twisting motions of the spine, or do any heavy lifting for
several months.
IDET is taught in some pain fellowships, has 510K FDA clearance, and
has several double blind studies supporting modest effectiveness in
reducing low back pain. (see links to literature references to the left)
Link to the manufacterer's site: IDET
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